This application relates to surgery for repair of injured articulating joints between bones in mammals, and to a method and a device for use therein.
The caudal and cranial cruciate ligaments are the primary stabilizers of the stifle joint in mammals such as canines. The caudal cruciate ligament originates from the lateral side of the medial femoral condyle and inserts on the medial aspect of the popliteal notch of the tibia. The cranial cruciate ligament originates from the medial side of the lateral femoral condyle and inserts on the cranial medial tibial plateau. In canines, the stifle joint is normally capable of flexion and extension with a 110 degree range of motion, varus and valgus angulation, and internal and external rotation. The stifle is extended by the quadriceps muscle group. Injury to a cruciate ligament will commonly result in destabilization of the joint. The joint must be surgically stabilized following such an injury.
Current surgical techniques for anterior cruciate ligament replacement and/or stabilization in canine knee or stifle joints are grouped into extracapsular procedures and intracapsular procedures. Intracapsular procedures require a graft from an adjacent tissue such as the straight patellar tendon or the fascia lata, which is detached from its origin and inserted or repositioned through tunnels bored in the distal femur and/or proximal tibia. This surgery is done inside the joint capsule, with both ends of the transplant being fixed to the walls of the tunnels and/or adjacent bone. Extracapsular procedures use tissues or suture implants placed outside of the joint capsule in order to stabilize the joint.
Determination of the isometric relationship between location of the origin and location of the insertion of a ligament repair structure forms the foundations of intracapsular surgical repair of ligaments in humans. These same isometric relationships may be determined and used for extracapsular repair of cruciate or other ligament failure in the joints of any mammal. However, current extracapsular surgical procedures have not addressed the optimal placement of transplant tissue or suture at the isometric points.
What is needed then is a surgical device and procedure for repair of a ligament that provides for the determination of optimal points for the attachment of graft, transplant, or other tissues or tension-bearing materials in an extracapsular procedure.